This proposal is an application for a continuation of Phase 111 of the Automated Physician's Assistant Project (APA). Previously, during Phase 111, the project has attained several major objectives including: 1) the development of a methodology for implementing the design of an ambulatory care system; 2) the development of a technique for both pre and post evaluation of the effect of introducing a change in a component of a health care delivery system and 3) the development of an integrated software system of medical services (Clinical Assistance System, CLASS) using the MUMPS system and incorporating the results of other development efforts. With these accomplishments in hand, the goal of the proposed continuation effort is to implement and evaluate the design methodology for ambulatory care in several settings typical or rural practice.